WI0800537_Permit (Issuance)_20200716

MINERAL
SPRINGS
environmental, p.c. 4600 Mineral Springs lane Raleigh, NC 27616 919-261-8186
July 16, 2020
Michael Rogers
North Carolina Department of Environmental quality
Division of Water Resources
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Reference: Notification of Intent To Construct or Operate
Air Sparge/ Vacuum Extraction System
Han Dee Hugo's # 28
Wilmington, North Carolina
MSE Job # 1023
Dear Mr. Rogers:
Please find attached the Notification of Intent forms to construct an air sparge/soil
vacuum extraction remediation wells at the above referenced site. NOI forms are
attached for the property with address 5002 Market Street. Up to 11 air sparge wells will
inject air into the subsurface. The system should be operational by the end of
September 2020.
If you have any questions regarding the report, please contact me at [phone].
Sincerely,
Mineral Springs Environmental, P.C.
Kirk B. Pollard, L.G.
President

North Carolina Department of Environmental Quality — Division of Water Resources
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are `permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of I5A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to injection
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations —Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
IJ11Y_8
A.
B.
C.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
20 PERMIT NO. W10800537
(to be filled in by DWR)
WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well......................................Complete sections B through F, K, N
(2) Aquifer Test Well.......................................Complete sections B through F, K, N
(3) Passive Injection System...............................Complete sections B through F, H-N
(4) Small -Scale Injection Operation ......................Complete sections B through N
(5) Pilot Test.................................................Complete sections B through N
(6) Tracer Injection Well...................................Complete sections B through N
STATUS OF WELL OWNER: Choose an item.
WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s):
Mailing A
City: LL&a hvt, State: NC Zip Code: Z& 3Z County:,5Q 56x.
Day Tele No.:
Cell No.:
L�lu1:�11I:�hl�
Fax No.:
Deemed Permitted GW Remediation N0I Rev. 3-21-2018 Page 1

53
E.
F.
G.
H.
PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: od' L. %'l T-4-e
Company Name A' L ` ""''. /L�Ii.e .
Mailing Address: 9W6 d0tlt i4e' W Gyp
City: 9&k i-d it L State: e_ Zip Code: Za/o County:
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title:
Company Name.
Mailing Address:
City:
Day Tele No.:
W57 _:3 IA
Zip
Cell No.: �,%q %go— p 3;3,%
EMAILAddress: /LA1pi1Q✓/r@ l?C. rr. cjG)Jr\, Fax No.:
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name&Address: dAn %E.GG AAaS *OSPJ
�Tt�LL
City: GcriLL County: clt) IQAID�ULVZipCode:
(2) Geographic Coordinates: Latitude**: y2 / + It, or °
Longitude**: W 78 4y , or °
Reference Datum: Accuracy:
Method of Collection: (1 BOA I
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
TREATMENT AREA
Land surface area of contaminant plume:_�--O�fJ square feet
N
Land surface area of inj. well network: 19 square feet (< 10,000 R2 for small-scale injections)
Percent of contaminant plume area to be treated:#0 (must be < 5% of plume for pilot test injections)
INJECTION ZONE MAPS — Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and
vertical extent of the contaminant plume in soil and groundwater, changes in lithology, existing and
proposed monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus
existing and proposed wells.
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 2

I.
DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -- Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and
duration of injection over time.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant (attach additional sheets if necessary).
NOTE Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at http://deq.nc.gov/about/divisions/water-
resources/water-resources- ermitslwastewater-branch/ round -water- rotection/ round -water -a raved-injectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info
(919-807-6496).
Inj ectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
Inj ectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
Inj ectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: / / Proposed Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-Is, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built). -
(a) Well type as permanent, GeoprobelDPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 3

L.
M.
SCHEDULES — Briefly describe the schedule for well construction and injection activities.
MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Si
g1rclumter 021. result fio,n the injection activity.
N, SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owne Mlicant: "I hereby cert�&, under penalty of• law, that I am familiar with the information
submitted !it this document and all attachments thereto and that, bared on nay inquiry of those individuals
inunediately responsible for obtaining said hi(br•rnation, I believe that the iVorination is true, accurate and
complete. I tam. aware that there are significant penaltics, including the possibility of fines and in prlsonnient,
for submitting false hlforinatiom I agree to construct, operate, maintain, repair, and a,'fiapplicoM abandon
the Infection nv Il ar cl all refuted appauYenane¢s a accordance wilt the " NBC (12C Q?Of1 Rules." y
_-rr� --� i�ar�t1oA /)1.�Cdr teSi(�enl
Signature of Applicant Print or Type Full Name and Title
Property Owner (if the prorierty is not owned by the Well QwnerLApplic l);_
"As owner of the property on which the it jection well(s) are to be constructed) and operated!. I hereby consent
to allow the applicant to construct each injection well as outlined in this application and agree that it shall be
the responsibility of the applicant to ensure that the infection well(s) conform to the Krell Construction
Standards (1IANCAC 02C..QQt1).
"Owner" means any person who holds the fee or other property rights in the well being constricted. A
well is real property and its construction on land shall be deemed to vest ownership in the land owner, in
the absence of contrary agreement in writing.
VerlaleJ by PDFfllter K �— v
Kimberl Honbarrier Plaut, President l,/�,erlN Nondarrter FIaUOfi(19/2020
Signnutre* of Property Owner (if different from applicant) Print or Type Full Name and Title
Mn access agreement between the applicant and property owner may be submitted in flea ofa signature on this,fbrrn,
Please send I (one) hard color copy of ]its NOT along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
'Telephone: [phone],164
Deemed Permitted OW Remediation NO! Rev, 3-21-2018 Page 4

WELL NUMBER: 52' ► T/Vµc-lI
SITE: iiN-# tb
JOB N0: I043
SURFACE
CASING MATE Zd
DRILLING METHOD' IN5
CAD DATE: OCTOBER 2004
PROJECT NO: ADMIN
CAD FILE: ADMINCAD TYPE II
DRAWN BY: LOT
APPROVAL: KR
PROTECTIVE MANHOLE CASING
WITH LOCKABLE CAP
CONCRETE DOME
CASING RISER. Q -13
(�I iir
GROUT'
t,tm GY1 E o Y U
BENTONITE SEAL�11
AND GRAVEL PACK' ► I p 13
►3- 15`
,
TOTAL DEPTH-
l,�e 1) G�vl�'Ya-C�►' : �c-0.►ono�l rroU�
Cev &4t,vj 4P NG.33ZZR
STANDARD TYPE II BELOW GRADE
MONITORING WELL CONSTRUCTION SCHEMATIC
REFERENCE: I DRAWING NO:

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